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Independent Predictors of Readmission following Left-Atrial-Appendage Closure: Insights from the Nationwide Readmissions Database
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  • Malik Bilal AhmedOrcid,
  • Wasiq SheikhOrcid,
  • Anshul Parulkar,
  • Esseim Sharma,
  • Kevin Kennedy,
  • Zara Ahmed,
  • Sanchita Singal Parulkar,
  • Brian McCauleyOrcid,
  • Fabio Lima,
  • Antony Chu
Malik Bilal Ahmed
Orcid
Brown University Warren Alpert Medical School
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Wasiq Sheikh
Orcid
Brown University Warren Alpert Medical School
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Anshul Parulkar
Brown University
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Esseim Sharma
Brown University
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Kevin Kennedy
Saint Luke's Mid America Heart Institute
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Zara Ahmed
University of Alabama at Birmingham School of Natural Sciences and Mathematics
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Sanchita Singal Parulkar
Brown University Warren Alpert Medical School
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Brian McCauley
Orcid
University of Pennsylvania Perelman School of Medicine
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Fabio Lima
Brown University
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Antony Chu
Brown University
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Abstract

Objective To analyze the incidence, predictors, and cost of 30-day left atrial appendage closure readmissions utilizing the Nationwide Readmissions Database (NRD) and to develop a scoring system to predict readmission risk. Background Determining incidence and predictors of 30-day readmission post-left atrial appendage closure can direct resources towards high-risk patients. Methods International Classification of Diseases, Tenth Revision (ICD-10) codes were used to identify patients. We excluded patients who were discharged or died in December 2016. Influential factors were identified by univariate analysis and clinical suspicion. Continuous variables were compared using the Student’s T-test and categorical variables were compared using chi-square or Fisher’s exact test. A logistic regression model and scoring system were developed and validated. Results 2975 patients were identified and 243 (8.2%) readmitted within 30 days. Non-routine disposition (p<0.0001), chronic pulmonary disease (p=0.0003), renal disease (p<0.0001), and anemia (p=0.009) were significant predictors of readmission. Readmitted patients had longer lengths of stay (2.8 days ± 4.8) and higher charges ($139,869.3 ± 94,574.3). Average length of stay and cost for rehospitalizations were 4.8 days ±4.9 and $62,577± 85,850. Top causes of readmission included atrial fibrillation, atrial flutter, congestive heart failure, sepsis and gastrointestinal bleeding. Mortality during rehospitalization was 1.2%. Our scoring system had a C-statistic of 0.679 (derivation) and 0.633 (validation). Conclusion Readmitted patients have longer and more expensive initial hospital admissions, and chronic cardiac, pulmonary, and renal issues. A simple scoring system may identify patients at risk for readmission